Single Unit Revenue Code Roll Up

File Maintenance Help for NextGen® Enterprise 8

CPT4 Roll Up

A CPT4 roll up combines the total charges for SIMs using the same CPT4 code into a single charge. If you enter an alternate CPT4 code for a SIM designated to perform CPT4 roll up, the application combines the charges with the alternate CPT4 code. To combine the total charges from SIMs using different CPT4 codes, each SIM included in the roll up must be mapped to the same alternate CPT4 code. You can perform line item roll-ups in the following instances: The separate line item charges are totaled. The quantity of line item charges are "rolled up" to become a single charge. CPT4 roll up is used primarily by CHC (Community Health Clinic) clients. The CPT roll up takes multiple line items that are flagged and have the same CPT code or alternate CPT code and rolls them up into a single line item and changes the quantity to one – the total sum of the charges appears on the line item. Activate a CPT4 Roll Up Parent topic: Payer Tab - SIM Library

File Maintenance Help for NextGen® Enterprise 8

Unbundle Service Item Codes by Payer

You can unbundle (not group the same service items together as multiple units) Service Items Codes by payer or by practice. This option is available to accommodate payers who do not want to be billed with multiple units of the same service item; they prefer each service item listed separately, each with a unit of one. When SIMs are set to unbundle, separate charge lines generate. You can prevent SIM bundling: for all payers in a practice. of all SIMs for a specific payer. for a specific SIM and payer combination. When you prevent bundling, multiple identical charge lines are prevented from being combined on one line and summed on the paper claim. The identical charges display on separate lines on the paper HCFA 1500 claim or are entered individually in an electronic send file. When the check box is cleared (the application default), the application sums identical line items and indicates multiple units for billing on a paper HCFA 1500 or in an electronic send file. To Activate Unbundli

File Maintenance Help for NextGen® Enterprise 8

Activate a Single Unit Revenue Code Roll Up

Open a Service Item library and then select a SIM. Select the Payer tab. Select the Single Unit Revenue Code Roll Up check box. Select this check box if you want the application to roll up charges that are associated with the SIM's revenue code and have a quantity of 1 when the claim is billed. Parent topic: Single Unit Revenue Code Roll Up

Help Guide for NextGen® Enterprise PM 8

Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code provides the ability to roll-up multiple charges on an encounter into one line item on the claim. Each line item represents a specific revenue code. This setup could be used for Medicare at a Rural Health Center to create a claim where all non-preventive services are rolled-up to a single 0521 revenue code line item. Important Note: Best practice is to use Encounter Rate Billing for both Medicare and Medicaid. In some cases, Roll-Up by Revenue Code will not meet the billing and claim requirements for a payer (e.g. FQHC Medicare). Before proceeding with the setup for roll-up billing, always consult with a NextGen Healthcare Implementation Specialist and a Claims Analyst to confirm that this is the best setup option to meet the payer's specific billing requirements. With this setup, all SIM codes on an encounter with the same revenue code will roll-up to a single line item on a claim and the amount on that line item will equal the total sum of the rolled-u

Help Guide for NextGen® Enterprise PM 8

Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code provides the ability to roll-up multiple charges on an encounter into one line item on the claim. Each line item represents a specific revenue code. This setup could be used for Medicare at a Rural Health Center to create a claim where all non-preventive services are rolled-up to a single 0521 revenue code line item. Important Note: Best practice is to use Encounter Rate Billing for both Medicare and Medicaid. In some cases, Roll-Up by Revenue Code will not meet the billing and claim requirements for a payer (e.g. FQHC Medicare). Before proceeding with the setup for roll-up billing, always consult with a NextGen Healthcare Implementation Specialist and a Claims Analyst to confirm that this is the best setup option to meet the payer's specific billing requirements. With this setup, all SIM codes on an encounter with the same revenue code will roll-up to a single line item on a claim and the amount on that line item will equal the total sum of the rolled-u

File Maintenance Help for NextGen® Enterprise 8

Payer Tab - SIM Library

On the Payer tab in the Service Item library, all of the billing information displays that is needed to correctly set up the service item with a specific payer so that the claims are promptly paid. Field Description Payer If a payer requires an alternate CPT4 or Revenue code for the service item, then select that payer name. If you need to set multiple payers, fill out the information for the first payer, then select a new payer. The window will clear, but the first payer's information is saved. Suppress Rendering/ Attending Loop You can select the option to determine whether the Attending (2310A) and Rendering (2310B) loops should be suppressed. Do Not Sum Units for CPT4 Code You can select this check box to indicate that for a specific payer and SIM combination, multiple identical charge lines are prevented from being combined on one line and summed on the paper claim. The identical charges display on separate lines on the paper HCFA 1500 claim or are entered individually in an elect

Single Unit Revenue Code Roll Up

Recommendations

CPT4 Roll Up

Unbundle Service Item Codes by Payer

Activate a Single Unit Revenue Code Roll Up

Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code

Payer Tab - SIM Library

Single Unit Revenue Code Roll Up

CPT4 Roll Up

Unbundle Service Item Codes by Payer

Activate a Single Unit Revenue Code Roll Up

Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code

Payer Tab - SIM Library